Organ Donation in America

Scientists call organ donations a "social necessity" for a reason: Thousands of lives have been saved since the first human organ was successfully transplanted in 1954. However, Americans in need are still at odds with a tragic reality –every year, the number of organ donations are far outnumbered by the number of people whose lives depend on them.

We set out to further understand organ donations in the United States by analyzing thousands of data points collected by the Organ Procurement and Transplantation Network (OPTN). Through this process, we discovered the painfully long line people wait in for a second chance at life. Read on to learn more about those who donate their organs to others, those who are in need, as well as the geography and demographic factors of the American organ donation system.

Organ Donation Overview

2018 marked a record number of organ transplants. But even so, there were still 113,000 people on the waitlist – and sadly, more than 5,800 individuals on the list died before receiving a transplant.

Before we dive into this complex medical situation, it's important to have a general understanding of the latest terms. For instance, a registered donor is a person who is authorized through a state registry to donate organs. Maybe you've noticed the opportunity to register when visiting the DMV. In the U.S., roughly 145 million people are registered donors, but less than 18,000 people in 2018 donated to the waitlist. Donors are people who give organs, and they can be individuals who (1) are registered to donate, (2) are not registered but give consent before their death, or (3) were not registered but their family gave consent after their death. Among donors in 2018, 6,831 were alive and 10,722 were deceased at the time of organ donation.

Who Are Registered Organ Donors?

Over the years, organ donation in the U.S. has garnered its fair share of rumors and misconceptions, whether it is that organ recipients somehow take on the personality of the donor or that organ donations incentivize medical professionals to withhold life-saving medical care to a registered donor in critical condition. These beliefs lead many people to stay off the registered donor list. This prompts an important question: Who are the people who have chosen to be potential donors? We surveyed nearly 1,000 individuals to get a sense of demographic trends.

Of our sample, 64% were registered to donate organs, while 33% were not. Interestingly, people in their 20s, 30s, and 70s were the most likely to be registered donors (in all of these age groups, more than 50% were registered). Middle-aged people, however, were most likely to opt out – 39.7% of people in their 40s and 41.5% of people in their 60s, for example, were not registered donors. When it came to gender, men were slightly more likely than women to be registered organ donors.

Trends in Supply vs. Demand

Managing your health is not a simple task when you consider all of the nuances of the human body's inner systems and the small ways things can go wrong, sometimes only detected through blood work and analysis. Imagine the experience of having an entire organ fail and entering a waiting list in order to avoid more serious illness or death. Unfortunately, individuals on that wait list are faced with another grave reality: In 2018, 17,600 people donated organs, while more than 113,000 waited for one. Are things getting better or worse?

As it turns out, the number of waitlist candidates has skyrocketed in the last few decades, from less than 30,000 in 1992 to about 120,000 in 2014. Kidneys, livers and hearts top that list of organs needed for transplant. During this same period, organs recovered and donated only marginally increased, although the trend lines suggest they are on the rise, while waitlist candidates have slightly fallen since 2014. However, a potential reason for the drop in waitlist candidates is bittersweet: The American opioid crisis is a significant reason for the increase in organ donations in recent years.

Grim Products of Overdose

Drug overdose deaths have been on the rise in recent years, and opioid overdoses, in particular, caused more than 47,000 people to lose their life in 2017. This crisis, however, has caused a somewhat unpredictable byproduct: an increase in the number of organ donations.

In 2017, nearly 2,200 organ donors were people who died from drug overdoses. That's 13.4% of all donors, according to the Annals of Internal Medicine. Perhaps understandably, this has caused some mixed feelings. About 37% of those surveyed said, hypothetically, they would not accept an organ donated by someone who died from a drug overdose. That's almost as many people – 41% – who said they would not accept an organ donation if it were infected with a disease or virus that was curable. This is despite a recent breakthrough in medicine that has allowed hepatitis C-positive organs to be donated since these organs can be cured. In 2018, 803 hepatitis C-positive organs were transplanted in the U.S.

Waitlist Geography

Those needing an organ donation are at the mercy of geography, and not all states are created equal. In the past, wealthy individuals such as Steve Jobs were accused of gaming the system by moving to different parts of the country where the waitlist was shorter, for example. Given this reality, we decided to compare the number of people who donated organs to the number of people on the waitlist by state.

California was, by far, the biggest standout for the highest number of waitlist candidates per donor, with 13.3 individuals waiting for every person who donated. Georgia, New Mexico, Massachusetts, New York, Maryland, and Hawaii also had some of the biggest gaps, with around nine or so waitlist candidates per donor. Meanwhile, Utah had the lowest number of waitlist candidates per donor – around three waitlist candidates per donor, followed by Maine, Alaska, Oklahoma, Idaho, Kansas, and Nevada.

Waiting Times

The American Transplantation Foundation estimates that 20 people die every day from a lack of available organ transplants, while another person is added to the waitlist every 10 minutes. But so much of this process depends on supply and demand, as well as the part of the country a waitlist candidate resides in.

We wanted to know which organs result in the longest wait times, plus where in the country residents typically waited the longest. Our results suggest that lung transplants had the shortest wait times. Sixty-seven percent of those who received a lung transplant waited less than a year, possibly because living donors can give a portion of their lungs. Kidneys had varying wait times for those seeking the organ for transplant, but are also the most common organ needed, and to date around 95,000 people are seeking one.

On the other hand, 26% of individuals who received an intestine transplant had to wait five or more years, making it the most likely organ to result in a long wait. Intestine transplants are known to be rare, and overall wait times among those who received an intestine transplant varied significantly. Eighteen percent of those receiving a pancreas and 15% of those receiving a kidney had to wait five years or longer, as well.

Among states, Alabama stood out for having the longest wait time, with nearly 31% of all transplant recipients waiting five years or more for an organ. In response, the state has enacted some progressive policies in recent years to incentivize organ donation, including a 2017 act that offers paid leave benefits to living donors.

Hawaii, California, New York, Minnesota, and Connecticut also ranked high on the list for the longest wait times.

Understanding Organ Donation

Every few years, more breakthroughs in medicine unlock further possibilities in the realm of organ donation. As it is, the current decade has already seen the first-ever successful facial transplant. Meanwhile, a single organ donor can save up to eight lives.

There is no doubt a persistent battle of supply and demand when it comes to helping those in need of organs, though. All of this research underscores an incredibly important truth: Many people are still in need, and we should try to do more – even by registering to donate – because that person may someday be us. Another lesson from this research is that we should value our health.

Your health is important to us at Health Testing Centers. Although cutting-edge technology in organ procurement may not be ready for us, you can take advantage of our safe, confidential blood tests, cancer screenings, and organ checkups by visiting us at HealthTestingCenters.com.

Methodology

We analyzed data on organ donors, organs recovered, and waitlist candidates from the Organ Procurement and Transplantation Network (OPTN). We examined discrepancies between donors and the number of waitlist candidates, as well as the number of organs recovered, by year and state to see which areas of America had the highest discrepancies between the number of donors and candidates waiting for an organ. We also included data from the CDC on overdose deaths to see how these deaths correlate to the rise in organs recovered and donors.

To calculate the number of people who had donated organs, we queried "donors," "donation year," and "donor state of residence." We queried "waitlist candidate" to find the distinct number of people on the waiting list to date. To view the number of deaths of waitlist candidates, we queried "waitlist removals," which describes patients removed from the waitlist a) by personal, voluntary choice, b) because they have become too ill to survive surgery or post-transplant immunosuppression, c) are recovering adequate organ function, d) have received a transplant, or e) have died. We supplemented our data analysis with a survey of 994 Americans in which 54% were women and 46% were men. Ages ranged from 18 to 85 with an average age of 37 and a standard deviation of 12 years. Due to the limitations of a survey, data may be subject to telescoping, exaggeration, and selective memory. We did not statistically test our survey-based hypotheses.

Fair Use Statement

If you're interested in sparking a conversation about organ donation in your community, please share our study for noncommercial purposes only. Maybe you'll inspire people to register as organ donors. Please don't forget to link back to us to give us credit for our work.